Comment gérer l’hypertension intracrânienne réfractaire ?

in Réanimation (2012), 21(S2), 319-324

Intracranial hypertension is one of the major causes of secondary injury in traumatic brain injury leading to a significant burden of morbidity and mortality. We here present a review of available ... [more ▼]

Intracranial hypertension is one of the major causes of secondary injury in traumatic brain injury leading to a significant burden of morbidity and mortality. We here present a review of available therapies for the treatment of refractory intracranial hypertension that is defined as an intracranial hypertension that does not respond to the firstline therapies. Second-line therapies that are available for the treatment of refractory intracranial hypertension include mild induced hypothermia, inotropes, and vasopressors for the control of cerebral perfusion pressure, transient hyperventilation, barbiturates, and decompressive craniectomy. Apart from decompressive craniectomy, these therapies are supported by the last guidelines published by the Brain Trauma Foundation (BTF). However, the level of evidence supporting them is low to moderate. This is probably partly explained by the fact that traumatic brain injury is extremely heterogeneous and requires multimodal and individualised care, which makes randomised clinical trials difficult to set up. On-going studies like those conducted on induced hypothermia (EUROTHERM3235) and on decompressive craniectomy (RESCUEicp) may lead to new perspectives for the management of patients suffering from refractory intracranial hypertension. [less ▲]

Réanimation métabolique du myocarde: à la redécouverte de l'insuline

in Réanimation (2010), 19

Le sepsis, réponse adaptée ou non à l’infection?

in Réanimation (2009), 18(4), 277-281

Sepsis, severe sepsis and septic shock were thought to be provoked by an overwhelming inflammation in response to an infectious process. This was documented in several animal studies. However, in human ... [more ▼]

Sepsis, severe sepsis and septic shock were thought to be provoked by an overwhelming inflammation in response to an infectious process. This was documented in several animal studies. However, in human sepsis, excess of inflammation is hard to be observed. Compartimentalization of the host response rather favors a systemic anti-inflammatory climate. Clinical situations are complex: on one hand, virulence factors of microorganisms can directly harm the host tissues, divert the defence mechanisms or distract the control mechanisms of the host, preventing the normal interaction of endogenous mediators. On the other hand, septic shock mostly occurs in patients experiencing previous organic or functional vital failures before the development of infection. The vulnerability of the patient appears therefore to be a key point in the severity of the disease. Enhancing the host defence mechanisms rather than inhibiting the inflammatory reaction may become a preferential option. [less ▲]

La décontamination digestive sélective: vieux démons ou .... jeune fiancée?

in Réanimation (2009), 18

Les échelles d’évaluation des états de conscience altérée

in Réanimation (2008), 17

L’évaluation de l’état de conscience revêt une importance clinique considé- rable. En effet, déterminer avec précision la sévérité de l’altération de conscience permet non seulement d’établir un pronostic ... [more ▼]

L’évaluation de l’état de conscience revêt une importance clinique considé- rable. En effet, déterminer avec précision la sévérité de l’altération de conscience permet non seulement d’établir un pronostic vital et fonctionnel mais aussi de suivre plus efficacement l’évolution clinique des patients avec lésion cérébrale et d’optimaliser l’utilisation des ressources disponibles. Dans cet article, nous passons en revue les principales échelles d’évaluation des états de conscience altérée. Nous nous intéressons particu- lièrement à instrument récemment publié, l’échelle «Full Outline of UnResponsiveness» (FOUR). En effet, cette dernière constitue une avancée considérable dans l’évaluation cli- nique des patients présentant un état de conscience altérée. Parmi les apports de cette échelle, on notera sa contribution au diagnostic d’un locked-in syndrome, d’un état de conscience minimale ou encore d’un état de mort cérébrale. Nous pensons qu’en rai- son de son apport à l’examen clinique durant la phase initiale d’un état de conscience altérée, l’échelle FOUR devrait être préférée à la désormais classique échelle de Glasgow. [less ▲]

Detecting consciousness in minimally conscious patients

in Réanimation (2007), 16

Exactitude de la mesure continue de la concentration de glucose par microdyalise sous cutanée chez les patients de soins intensifs

in Réanimation (2006), 15(S1), 58-255

Intérêt de la cystatine C dans l’évaluation de la fonction rénale chez le patient hospitalisé aux soins intensifs.

in Réanimation (2003)

La fin de la vie en médecine intensive

in Réanimation (2001), 10